On June 14, the American Medical Association announced its recommendation to doctors Do not use body mass index (BMI) anymore Just as a way to assess health.
A decision to move away from trust The controversial height-to-weight ratio It is derived from the first data collected in part only on the earlier generations of the non-Hispanic white population.
In its statement, the AMA “recognizes the importance of considering differences in relative body shape and composition between race/ethnicity, sex, gender, and age when applying BMI as a measure of adiposity, and BMI should not be the sole criterion for denying appropriate insurance coverage.”
Instead, the AMA suggests that BMI should be used in conjunction with other tools to measure obesity, such as “visceral fat, body adiposity index, body mass, relative fat mass, waist circumference, and genetic/metabolic factors.”
Why is there a debate?
At the individual level, BMI has several weaknesses. But it can be a good tool to monitor the increasing or decreasing obesity in population.
It’s one of the reasons people love BMI. Simplicity: To estimate your BMI, take your weight in kilograms and divide it by your height in meters squared. Those with a BMI of 25 to 29.9 points are considered overweight, and those above 30 fall into the overweight category.
However, it is the simplicity of this formula that causes problems when evaluating individuals. BMI does not account for muscle and fat. For example, an athlete may have a low body fat percentage, but a high BMI, due to muscle mass.
When it comes to health, it can be even more important. where What BMI can’t tell you is how much fat you carry. For example, belly fat Associated with high blood pressureType 2 diabetes and Heart disease.
It is also possible to have a higher than average BMI and be generally healthy, condition It is called metabolically unhealthy obesity. This is probably due, in part, to how different bodies respond to fat. Different racial and ethnic groups It can also carry and handle weight differently..
There is also an important economic reason why BMI is not an indicator of weight and health. Insurance companies cannot cover medical expenses for people who do not fall into the appropriate category under BMI. For example, in May 2021, The Washington Post A black woman with an eating disorder reported being told her BMI was too high for medical coverage. She had to pay $800 a month out of pocket.
The tool may underestimate the number of people who are obese. The Endocrine Society annual meeting presented a new study BMI misses obesity issues Obesity is determined by the percentage of fat and muscle.
BMI is an imperfect tool, but it is one of the few screening options we have.
“Currently, the best tool readily available in any clinic would be a BMI-based test. We need better things. (AMA policy) is a push in the right direction, but we have to accept the reality of where we are now. – Obesity Treatment Dr. Carolyn Franville Brown STAT news
Focusing on BMI can affect the relationship between doctors and patients
“Clinicians’ focus on BMI can lead to unproductive weight-related discussions that break down the doctor-patient relationship and lead to mistrust. This can lead to patients choosing not to follow a doctor’s advice, even if the advice is not weight-focused, and not seeking follow-up care due to weakened trust, which undermines effective doctor-patient relationships.” An important component. Additionally, inaccurate BMI assessments can unnecessarily shift physicians’ attention to weight, an easy default but often incorrect explanation for a variety of signs and symptoms, and lead to missed diagnoses, sometimes with dire consequences. – S. Bryn Austin, Harvard Public Health TH Chan School Professor of Social and Behavioral Sciences and Dr. Tracy K. Richmond, Assistant Professor of Pediatrics at Harvard Medical School; MedPage Today
BMI may be more accurate than we think in detecting excess body fat.
Despite limitations and known counterexamples, BMI is highly correlated with body fat and accurately classifies people as having more than 80 percent body fat. More simple measurements like waist circumference can be more informative because they provide information about where fat is distributed in the body. – Kevin D. Hall, Senior Investigator, National Institute of Diabetes and Digestive and Kidney Diseases; The Washington Post
Waist-to-hip ratio can assess where fat is more dangerous than BMI.
“A person’s waist-to-hip ratio is a much better tool than BMI because it takes into account where fat is most problematic – the waist. It increases our risk for cardiometabolic diseases like heart disease and type 2 diabetes.'” – Dr. Fatima Cody Stanford, Obesity medicine doctor, Very good health
Relative Fat Mass (RFM) may be a better measure without the need for an index scale.
“The team of researchers behind RFM say that it is more accurate than BMI, and it can be done with just a tape measure – so you don’t need a set of measurements to calculate it like you do with BMI. In that case, the distance from your waist is measured in relation to your height, rather than your weight, the researchers said. They say it provides a better understanding of whether or not fat is at a healthy level. A reliable, simple and inexpensive method to assess body fat percentage without the use of sophisticated equipment, said lead researcher Orison Wolcott of Cedars-Sinai Medical Center in Calif. Our results confirm the value of our new formula in many disciplines. Relative fat mass is a better measure of body fatness than many indices used in medicine and science, including BMI.’” — Science alert
Even if BMI is not used, weight is still something to discuss with your healthcare provider.
“What I don’t want to happen because of this is that people of color and black people in particular ignore BMI and discuss overweight with a health professional because they don’t understand the purpose here. The goal is to personalize how BMI is used in medical decision-making and lead to stigma and discrimination.” It’s a departure from possible generalizations.” — Dr. Jamie Ard, professor of epidemiology and prevention at Wake Forest University School of Medicine. CNN
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